Alain Braillon, PhD
Potential Conflicts of Interest: None disclosed.
Braillon A.; Surveillance for Hepatocellular Carcinoma. Ann Intern Med. 2011;155:274-275. doi: 10.7326/0003-4819-155-4-201108160-00017
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Published: Ann Intern Med. 2011;155(4):274-275.
TO THE EDITOR:
Davila and colleagues (1) showed that in a series of 13 002 patients with hepatitis C virus infection and concomitant hepatitis C virus infection and cirrhosis, screening for HCC is an enduring mistake. Indeed, routine surveillance only occurred in 12.0% of this population. This poor surveillance rate may only suggest that health care professionals do not trust the recommendations made by advocates for screening.
Screening is a complex issue that necessitates a national program to ensure a minimum participation, quality controls, and evaluation of the results; these basic requirements are missing for screening for HCC. The program must be defined by evidence-based surveillance tests. Measurement of serum α-fetoprotein is inadequate regardless of the cutoff value; ultrasonography is operator-dependent, and many clinicians prefer computed tomograpy (CT); and the interval between tests varies from 4 to 12 months.
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